Monday, May 21, 2012

Hospital Acquired Infections

The closure of eight wards at Royal Alexandra Hospital in Paisley because of an increase in people showing symptoms of the Norovirus bug has thrown the spotlight back on HAI's. Two people suffering from diarrhoea and vomiting died in the hospital. NHS Highland also reported an increase in the number of cases of diarrhoea and vomiting with Raigmore Hospital in Inverness closing two wards to new admissions and a ward at Caithness General is also shut.

Scotland's Chief Medical Officer, Sir Harry Burns has stressed that Norovirus cases were decreasing in number, saying: "The number of cases of norovirus, the number of outbreaks, has fallen over the past few years. So things are stable and probably going in the right direction. It's something we are seeing less of, a 16% reduction in the figures over the past two or three years."

Sir Harry also highlighted the importance of hygiene in tackling the virus: "Hand-washing is probably one of the most important things we can do. It is dealt with by soap and water; conventional clean hands. Hand hygiene among NHS staff in Scotland at an all-time high".

More generally on HAIs, the Health Protection Scotland Point Prevalence Survey, which involved 13,558 patients, 844 wards and 75 hospitals, records a snap shot of all types of infections on the day of the survey. The April 2012 report highlights that prevalence of healthcare associated infections was 4.9 per cent in acute hospitals and 2.5 per cent in non-acute hospitals – a significant reduction on 2006 levels.

Health Secretary, Nocola Sturgeon commented,  "the overall level of infections has reduced by one third since 2006 and cases of some types of infection which cause particular concern, such as C.diff and MRSA blood stream infections, have fallen by over 75 per cent. This is good news but I am in no doubt that there is still more that can be done as we strive to embed quality in all aspects of patient care in Scotland. This is a substantial report and so I have asked the HAI Task Force National Advisory Group to consider the report’s findings and to provide advice on its implications for future HAI policy and priorities.”

So good progress, however, HAI's are a long way from being eradicated. On average at least one patient in every 20 on a ward in acute care at any one time has an HAI.  Scottish Labour's Shadow Health Secretary, Jackie Baillie, said: "The fact six people have died in recent days, 20 wards have been closed and more than 100 people across Scotland are suffering from norovirus symptoms should be a stark reminder the battle against hospital superbugs is far from over."

Hand washing disciplines and infection control staff will probably help mitigate the worst aspect of the problem, but it will not alter the underlying reasons for the development of HAIs. This is beacuse they are an unintended consequence of the factory style hospital care we have developed in recent years. Occupancy and bed turnover rates are at an unheard of level. This together with waiting time targets put constant pressure on hospitals to move ever increasing numbers of sick people through the hospital, together with a similar increase in different vistors.

We also have non-NHS reasons for the increase including farmers using antibiotics. Again, something that is unlikely to change quickly. The overall proportion of bloodstream and urinary infections has risen, with E.coli a growing problem in both. Health Protection Scotland has reported that the prevalence of E.coli was higher (20.8% versus 6.7%) than that reported in the previous Scottish PPS (survey). It confirmed the growing resistance to antibiotics although even this could not account for the rising prevalence of E.coli in Scottish hospitals.

So while an army of protocols, staff and lotions are mitigating the problem of HAIs, we should remember that the underlying cause is in our factory approach to modern acute care. That isn't going to change quickly, if at all.

1 comment:

  1. Let us hope that healthcare workers are not too scared to report HAIs in the same way they have recently been for reporting waiting time targets...